Nghiên cứu đặc điểm biểu hiện Her2 ở bệnh nhân ung thư biểu mô dạ dày tại bệnh viện Việt Đức

NGHIEN CUU DAC DIEM DIEU HIEN HER2 6 BENH NHAN UN6 THU DIEU MO DA DAY

TAI DENH VIEN VltT Dlfc

DAT VAN 0 £

Ung thu1 da ddy (UTDD) Id mdt trong 4 loai ung

thu> thudng gdp nhit trdn the gidi vdi khoang 1 trieu

ca m ic mdi mdi ndm. Ty Id tu vong do UTDD cao thu

2 sau ung thu ph6i [1], Thdi gian sdng cua bdnh nhdn

UTDD giai (Joan tien triln duac dieu tri bdng hda chit

Id rit th ip vd rit c in cd mdt lieu phap mdi. HER2 Id

mot dau in phdn tu thudc ho thu the cua y iu td phdt

triin biiu md (EGFR- Epidermal Growth Factor

Receptor) budc d iu cho th iy cd vai trd tidn luong vd

giup cho lua chon BN phu hop cho diiu trj dich [2]

Ddc <Jiem bdc Id cua d iu in ndy vd cdc ung dung

cua nd dd duoc th i gidi nghidn cuu trong nhiiu ndm

qua. Tai Viet Nam v in d i ndy mdi chi duoc cdp nhdt

trong thdi gian g in ddy. Chung tdi tiin hdnh nghidn

cuu ndy nhdm muc tidu: ddnh gid muc dd bieu hidn

Her2 vd mdt sd y iu td cd lidn quan d bdnh nhdn ung

thu da ddy duoc phiu thudt tai bdnh vidn Viet Due.

d 6| TU’CXNG PHU’aNG PHAP NGHIEN CLfU

1. Ddi tuang nghidn ci>u

T it ca cdc bdnh nhdn (BN) UTDD duo’c mo tai

benh vidn Viet Due cd k it qua giai phdu benh Id ung

thu bieu md (UTBM) vd duo’c Idm xdt nghidm Her-2

trong thdi gian tu thdng 3/2012 den thdng 6/2013

Tidu chuin lua chon: BN cd d iy du k it qua giai

phiu benh: nhdn xdt dai the (kich thudc u, vj tri u,

dang ton thuong lodt, sui hodc tham nhidm), k it qua

nhuom (Hematoxilin - Eosin) HE thudng quy vd phdn

loai md benh hoc.

Tidu chuin loai tru: BN cd xet nghidm Her-2

nhung khdng du cdc thdng tin trdn hodc khdng phai

UTBM.

2. Phuang phdp nghien cuu: Tien cuu md ta

cdt ngang

3. Quy trinh xdt nghidm gidi phiu benh benh

phim da ddy, hach

Bdnh phim sau khi liy ra khdi ca th i duac gui

xuing khoa giai phiu benh, tuy nhidn do chua cd quy

djnh chdt che ndn thdi gian c6 djnh chua duac thdng

nhit. Chung tdi co djnh benh phim vdo cdc thdi

diim: gui tuc thi ngay trong mo, trudc 30 phut sau

m6, 8 gid sdng vd 15 gid chieu hdng ngay. Dung djch

c6 djnh Id formon dem trung tinh 10%.

Bdnh phim duac phdu tich, pha, chuyen, due, c it

mong r6i g in Idn lam kinh. Nhudm theo hai phuang

phdp HE vd hda md midn djch (HMMD).

Cdc bdnh phim duac nhudm HE thudng quy, doc

dudi kinh hiin vi quang hpc, phdn loai md bdnh hoc

theo cdc tidu chi dudi ddy:

- Phdn loai theo t6 chirc y te th i gidi: UTBM tuyin

nhu, UTBM tuyin 6ng, UTBM tuyin nhiy, UTBM t i

TRjNH HONG SON, NGUYEN THANH KH|£m ,

PHAM KIM BiNH, HO DlfC THUONG

bdo nhdn, UTBM tuyin- viy, UTBM viy. UTBM t l

bdo nho, UTBM khdng bidt hod

- Phdn logi theo Lauren bao gdm loai rudt. logi

Ian toa vd loai hdn hop

- Phdn loai muc do bidt hda dua vdo ty Id khdi u

chua cdc dng tuyin: UTBM bidt hda cao (>95% khdi

u chira cdc tuyin), UTBM bidt hda vua (50-95% khdi

u chua cdc tuyin), UTBM kdm bidt hda (5-49%) khdi

u chua cdc tuyin, khdng bidt hda <5% khdi u cd

chira cdc tuyin.

4. Ky thudt nhuom hda md midn djch

Doc ky tidu ban nhudm HE thudng quy. ddnh gid

tit ca cdc vung, lua chQn nhung vung ung thu xdm

nhdp d i nhudm HMMD. Trong trudng hop UTDD cd

nhieu mire bidt hda khde nhau, lua chon vung bi$t

hda cao, rd c iu true tuyin d i Idm HMMD

Tu thdng 3/2012 d in thdng 6 2012 nhudm tay vdi

khdng th i 1 Her2- neu cua hang Dako code A 0485,

ndng dd pha lodng 1/200. Ti> thdng 1/2013 d in thdng

6/2013 sir dyng bd kit Herpestest cua hdng Roch

nhudm mdy BENCHMARK-XTA/ETANA

Doc tieu ban HMMD cd ddi chiiu vdi tidu ban HE,

ddnh gid cdc muc dd bdc Id HER2 theo tidu chuin

cua nhd san xu it vdi 4 mire dd tu 0 d in 3+

0: hodn todn khdng b it mdu.

1+: khdng nhin th iy hodc nhdm mdng bdo tuong

dudi 10% t i bdo u.

2+: mdng bdo tuang b it mdu tu y iu d in trung

binh, th iy trdn 10% t i bdo u.

3+: mdng bdo tuang b it mdu todn bd vdi cudng

do manh th iy tren 10% t i bdo u.

K it qua 0 vd 1+ Id dm tinh, 3+ Id duang tinh, 2+

Id nghi ngd.

5. Quan ly vd phdn tich sd lidu

Quan ly vd phdn tich sd lidu bdng phin mlm

SPSS 18.0, so sdnh cdc ty Id bdng phdp kiim dinh

khi binh phuang vdi m ircy nghTa p< 0 05

K£T QUA NGHIEN CUU

Tu thdng_ 03/2012 d in thdng thdng 6/2013 cd 86

BN duac phdu thudt vd Idm xdt nghidm Her2. k it qua

thu duac nhu sau (bang 1):

Bang 1: Lidn quan giua b iiu hidn Her2 vd cdc yiu

T6ng Her2 3+

Dirong

tinh

Her2 2+

Nghi

ngd

Her2 1+ j Gid

dm tinh tn p

Tu6i 0 82

> 60 32 5(15,6%) 3(9,4%) 24 (75%) I

<60 54 6(11,1) 6(11,1) 42(77 8,

Gidi 0.92

Nam 62 8(12,9) 7(11.3) 47(75 8)

NO 24 3(12,5) 2(8,3) 19(79 2) I

18 Y HOC THITC HANH (902) - S6 1/2014